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Wednesday, September 30, 2020

Male Hypogonadism – Types, Causes, Symptoms, and Diagnosis

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In the world today, we have two genders, the male and the female gender. What differentiates us is the kind of hormones that are produced from our sex organs, which are otherwise known as our gonads.

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When our sex organs excessively produce hormones, it is a problem, and when they don’t produce enough, it is another issue.

When the sex organs produce a reduced amount of hormones, it is known as hypogonadism. The gonads primarily are the testes in men and the ovaries in women. The hormones that are produced from these sex organs are responsible for the differences between men and women.

These hormones control our secondary sexual characteristics such as the development of the mammary glands of the female, especially after puberty, testicular development in men, pubic hair growth in both genders, broadening of the chest and shoulders in male, just to mention a few.

One of the most essential activities that the sex hormones play in the life of a woman is the regulation of the menstrual cycle, and in males, it is the production of the male spermatozoa. These activities are very vital as they allow for the continuity of human life.

Hypogonadism generally affects both males and females, but for the sake of this article, we would be restricting the information to only the male hypogonadism. Male hypogonadism is said to occur when the body of the patient doesn’t produce enough testosterone.

Testosterone is the male hormone that is responsible for the growth and development of a boy into a man during puberty. This means that without this hormone, the boy even as he grows older, won’t have mature sex organs or enough sperm or probably have both conditions.

One can be born with this deficiency or might develop it later in his life as a result of an infection or as a result of a trauma or an injury.

Types of male hypogonadism

There are two types of male hypogonadism, and they are:

1. Primary male hypogonadism

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Another name for this type of hypogonadism is a primary testicular failure. The primary male hypogonadism is often as a result of a problem with the testicles of the male. The testis is a male organ that is responsible for the production of the hormone testosterone.

Once there is an issue with the testicles, it may affect the production of testosterone, and once that happens, the patient will experience symptoms of hypogonadism.

2. Secondary male hypogonadism

In this kind of hypogonadism, unlike the primary one, the patient doesn’t have an issue with his testicles. However, the problem may probably be coming from his pituitary gland, which is otherwise known as the Master’s gland or from the hypothalamus.

Generally, when there is any form of an imbalance in the body, the nerves send an alert to the hypothalamus. Once the hypothalamus gets this signal, it instructs the pituitary to give the signal for the production of the hormones that are deficient. This is also the same when it comes to sex hormones.

Once testosterone is deficient, usually, signals are sent to the hypothalamus, which will cause the hypothalamus to send messages via the gonadotropin-releasing hormone to the pituitary gland to control the production of the follicle-stimulating and luteinizing hormone.

Once the pituitary gland gets this signal, it sends impulses to the testes through the luteinizing hormone so that testosterone can be produced.

Now, once there is an issue with either the pituitary gland or the hypothalamus, there will be a low production of these hormones, and inadvertently, the production of testosterone will either be limited or completely stopped.

Congenital or inherited traits, infection, as well as injury, can cause any of the two types of hypogonadism. One should take note that both the primary and secondary male hypogonadism can occur at the same time, and as such, making it difficult to treat.

Causes

The causes of male hypogonadism depend on the type of hypogonadism the patient is experiencing.

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1. Common causes of primary male hypogonadism

– Kleinfelter syndrome

This syndrome occurs as a result of a congenital or inherited abnormality of the sex X and Y chromosome. Typically, a male has the XY chromosome, which means that a male has one X chromosome and one Y chromosome.

However, when a male has a Klinefelter syndrome, he has a new X or XX chromosome making the entire chromosomes XXY or XXXY chromosomes, which represent a deformity. The Y chromosome is what usually represents the sex of a child as well as its associated development.

When there is a new X or XX in Klinefelter syndrome, there will be an abnormal development of the testicles, which will, in turn, cause the underproduction of testosterone altering the development of the man.

– Undescended Testicles

During intrauterine life, the testicles are found within the abdominal region, and at birth, the testicles will then descend into the scrotum. However, in some cases, it is not so. Sometimes, one or both testicles won’t descend after birth.

Although this condition is mostly seen to correct itself after birth without treatment, some don’t and, as a result, cause the malfunctioning of the testes leading to the underproduction of testosterone if it isn’t corrected after birth.

– Mumps

Mumps orchitis or mumps, as it is popularly called, is an infection that usually attacks the testicles during adolescence or adulthood. This infection has the capacity of destroying the testicles and, as such, reducing the production of testosterone effectively, causing primary male hypogonadism.

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– Hemochromatosis

This is a disease condition that is characterized by too much iron in the blood circulation. Typically, the red blood cell is made up of hemoglobin, which is formed from both the heme (iron) part and the globulin part.

Once there is too much iron in the blood, it can lead to failure in the function of the testicles (testicular failure) or pituitary gland, which can eventually lead to a decreased production of testosterone.

– Injury to the testes

The testes are open to injury, and this is because it is no longer in the abdomen; instead, it is in the scrotum. Once there is any injury or any damage to the testicles, it can lead to hypogonadism by cutting off the total production of the testosterone hormone.

However, if the injury is to only one testis, there might be a decreased level of the production of testosterone.

– Cancer Treatment

Chemotherapy and radiation therapy that is mostly used I’m treating cancer often cause a malfunctioning of some organs, including the testes. Research has shown that chemotherapy can lead to the low production of testosterone as well as reduced production of sperm. Though these treatments are temporary, however, they can cause long term problems such as infertility.

Doctors have often advised men who want to undergo chemotherapy to try and preserve their sperm before the procedure is carried out.

2. Secondary male hypogonadism

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In secondary male hypogonadism, the major problems aren’t from the testes. However, the problem is from the hypothalamus or the pituitary gland. The causes of secondary male hypogonadism include

– Kallman’s Syndrome

This syndrome often occurs as a result of the abnormal development of a particular area of the brain that is known as the hypothalamus.

The hypothalamus is what controls the pituitary gland and causes the secretion of certain hormones such as follicle-stimulating hormone as well as the luteinizing hormone.

Asides the lack of production of these hormones, a person who has this syndrome will have an issue with his eyes causing red-green color blindness, as well as his ability to smell properly, which will be hampered causing anosmia.

– Disorders of the Pituitary Gland

When there is a disorder in the pituitary gland, there will be an impairment in the release of hormones, which in this case, is the release of follicle-stimulating hormone and luteinizing hormone from the pituitary gland to the testes. As such, the production of testosterone will be impaired.

Any tumor located in the pituitary gland or in any part of the brain that is located close to the pituitary gland will cause hormonal deficiencies, including that of testosterone.

Sometimes, treatments for brain tumors via chemotherapy or surgery can affect the pituitary gland and, as such, cause hypogonadism.

– Inflammation

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Some inflammatory disorders, such as histiocytosis, sarcoidosis as well as tuberculosis, have an extended effect of causing problems within the hypothalamus as well as the pituitary gland.

Once this occurs, the production of testosterone and other hormones will be tampered with, as such, leading to hypogonadism and other related hormonal diseases.

– HIV/AIDS:

One of the effects of HIV is that it causes the levels of testosterone to be severely reduced. This is due to the fact that this disease affects the hypothalamus, the pituitary gland, the testes, and other organs when it is not treated correctly.

– Obesity

When a person is severely overweight or becomes obese, it causes a deposit of fat in the arteries, which includes the testicular artery. These deposits of fat can lead to blockage, effectively cutting off blood supply to the testes and, as such, reducing the production of testosterone.

– Some medications

The use of some drugs such as opioids and its relations can cause a reduction in testicular functions. Sometimes, the use of certain hormones can also lead to a malfunction in testicular production.

– Age

A decline in age causes a reduction in the production of “everything typically.” This is also true in men. As they age, there is a slow, progressive reduction in the production of testosterone. However, the rate of decline varies from men to men.

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Symptoms of hypogonadism

The majority of hypogonadism usually begins during fetal life. However, some of them may start at puberty or even in adulthood. Signs and symptoms of hypogonadism depend on the stage at which it started.

1. During fetal development

Once the body begins to have difficulties producing testosterone during fetal development, one of the vital signs to be noticed is the underdevelopment of external sex organs.

However, depending on when the hypogonadism started and the amount of testosterone produced, a child who is genetically supposed to be a male can be born with:

  • Female genitalia
  • Ambiguous genitals. This kind of genitalia can’t be seen to be as a male or a female type.
  • Severely underdeveloped male sex parts.

2. During puberty

The majority of boys who experience hypogonadism at puberty usually struggle with having to attain puberty. This means that the child will experience a delay in puberty or experience an incomplete or lack of proper sexual development.

In other words, he won’t develop broad shoulders, deep voice, development of muscle mass especially around the shoulders, arms, thighs, and legs, growth of body and facial hair, growth of the testes and the penis as well as the production of sperm.

Instead, the child will start growing breast tissue, thereby having a disease known as gynecomastia, as well as increased growth of the arms and legs as compared with the trunk.

3. During Adulthood

When a male develops hypogonadism during adulthood, the male will experience an alteration in specific masculine physical characteristics, as well as a dysfunctional reproductive function.

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The early signs the patient will experience includes:

  • A decrease in his sex drive
  • Depression
  • A reduced level of energy.

After some time, if it is left untreated, the patient will experience more symptoms such as

  • Erectile dysfunction
  • Infertility
  • Reduction in the growth of hair on the body and on the pubic region
  • A decrease in muscle mass, especially on the shoulder region and the arms.
  • Osteoporosis is indicated with loss of muscle mass.
  • Development of breast tissue, as seen in gynecomastia.

When there is severe hypogonadism, the patient will begin to experience emotional changes as well as mental swings. As the testosterone decrease, some men also experience symptoms such as difficulty in concentration and hot flashes.

Diagnosis

Hypogonadism is mostly diagnosed after the patient is told to go for hormonal tests. Generally, you will be told to go for hormonal tests to check the levels of your follicle-stimulating hormone and your luteinizing hormone.

Once these hormone levels indicate any form of malfunctioning, then you will be started on a course of treatment your doctor deems fit for you.

Male Hypogonadism
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Disclaimer: This article is purely informative & educational in nature and should not be construed as medical advice. Please use the content only in consultation with an appropriate certified medical or healthcare professional.

Deborah Akinola
Wirter, poet and public speaker
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